Purpose: To provide a brief history of the development and evolution of health risk appraisal (HRA) and to review studies published in peer-reviewed journals that address the impact of worksite-based HRA on health-related outcomes.
Method: The Centers for Disease Control and Prevention conducted the primary literature search, identifying seven articles through a bibliographic search of major health databases, manual search of specific journals, and reference list search. We identified four additional studies from our personal experience and our manual search of previous reviews.
Important findings: Several studies reported positive changes in seat-belt use and self-reported physical activity associated with HRA participation, and changes in other health-related outcomes after HRA participation were also reported. Evidence supporting causal inference is lacking, however, because of the many threats to internal validity in studies completed to date. Almost no research has addressed the impact of HRA on health-related outcomes in the early "prebehavioral" stages of the change process, despite the theoretical and applied focus of HRA on these types of outcomes.
Conclusions: On the basis of the small number of studies in the literature, evidence is weak regarding the impact of HRA itself on health-related outcomes. There is suggestive evidence for the effectiveness of HRA when it is used in a comprehensive worksite health promotion program. Future research should focus on the impact of HRA on variables in the early stages of the change process, such as awareness and commitment, rather than on behavioral outcomes. Research should also address specific characteristics of HRA instruments and implementation approaches.